Motivational Interviewing and Behavior Change Session One Jayne
Motivational Interviewing and Behavior Change Session One Jayne Josephsen, Ed. D, RN, CCCTM, , CHPN 1
Objectives • • • Describe Motivational Interviewing Principles Differentiate Aspects of the Spirit of Motivational Interviewing Apply Motivational Interviewing to Caregivers Understand the Relationship Between Motivation and Change Identify Stages of Change and Motivational Strategies 2
Imagine… • Imagine that there is something • Now imagine your response… you want to change, and you have been thinking about it but have not made steps towards change yet • Now imagine that someone tells you how much you need to change and why and tells you to move on to changing what needs to be changed • • I am motivated to change I am irritated I feel misunderstood I am eager to leave the conversation I feel discouraged I feel judged I feel unwilling to change 3
What is Motivational Interviewing? • It is a conversation about change • The conversation allows a person to talk themselves into change • The change is based on their own values, beliefs, and life circumstance • It is based upon “guiding” not “directing” • Support, Motivate, Inspire, Encourage, Elicit, Accompany, Collaborate • It is a process • Occurs over time • All team members can be involved 4
Definition of Motivational Interviewing • “A person-centered, directive method of communication for enhancing intrinsic motivation to change by helping clients explore and resolve ambivalence. ” Miller & Rollnick (2002)
Spirit of Motivational Interviewing Partnership Acceptanc e Evocation Compassion 6
Principals of Motivational Interviewing • Change is self-change • • It is not a goal for change until the person makes it so People are experts on themselves We are not responsible to “make” change happen We don’t have to create solutions on our own People have strengths, resources, and motivations Change is a collaborative partnership: not a power struggle Motivation to change is already there it just needs to be evoked 7
The Process of Motivational Interviewing Engagin g Plannin g Focusin g Evoking 8
Process of Motivational Interviewing • Engaging • Build trust • Focus on process • Promote buy-in • Tool- OARS (Open ended questions, affirmation, reflective listening, summary) • Focusing • Clarify priorities • Collaborate on the conversation • Tool-Agenda Setting, Action Plan • Evoking • Identify barriers to change • Focus on past successes • Tool-Readiness Ruler, Responding to Change Talk • Planning • Collaborate on goals • Tool-Change Plan, Coping Plan • CHANGE IS A PROCESS NOT AN EVENT
Behavioral Change Context of Change, Stages of Change, Process of Change 10
Context of Motivation • Locus of control: Internal vs. External • Self identity: such as I am a smoker Self-efficacy: If the client believes they can make a change • Inner Conflict: “ Who wants to be healthy but unhappy” • Client’s Life Situation • Client’s Beliefs, Values, and Attitudes • Interpersonal Relationships • Social and Support Systems • Personal Characteristics • Ambivalence: Mixed feelings lead to indecisiveness 11
Stages of Change 12
Stages of Change • Precontemplation: The person may believe there is no problem or is engaged in sustain talk. • Encourage them to think about and discuss the behavior • Contemplation: The person begins to consider the behavior is a problem. May consider making changes with in the next six months • Continue to bolster motivation and assist in evaluating change options • Preparation: Person is ready for change within the next month • Build confidence, discuss timing of change, provided information and help client prepare for the change 13
Stages of Change Continued • Action: Person has started to modify the behavior in the last six months • Work toward maintaining engagement and support change by helping the person achieve small successive steps • Maintenance: Sustained change has occurred for at least six months • Support and reinforce commitment to change. To encourage change focusing on what is needed to avoid lapses or roadblocks • STAGES ARE NOT LINEAR 14
Strategies for the Precontemplation Stage • • Establish relationship Explore the meaning of events Elicit perceptions of the events Provide feedback – not advice Explore pros and cons Engage in problem solving Express concern and provide support 15
Strategies for the Contemplation Stage • Identify ambivalence • I want to change but I don’t want to change • Ambivalence is a normal part of change • Support decision toward change • Encourage examination of motivations for change • Guide through the pros and cons • Explore personal values and how they fit with change • Support autonomy and ability to change • Encourage statements of intent to change • Elicit expectations regarding the change 16
Strategies for Preparation Stage • • • Guide to clarify goals and expectations Explore options for change Elicit past successful strategies for change Collaboratively develop a change action plan Identify resources and strengths available to support change Explore any barriers for change and discuss how they might be addressed • Encourage support from significant others • If permission is given offer advice and additional information 17
Strategies for Action Stage • • • Encourage small steps towards change Explore any triggers that may initiate a relapse Develop a coping/action plan Reinforce changes made Continue to identify resources and strengths that support change With permission, continue to offer advice and information 18
Strategies for Maintenance Stage • • Affirm ability to maintain change Acknowledge changes Explore coping strategies Assist in processing relapses Monitor and review progress to goals Focus on long term goals Relapses occur but should not be a foregone conclusion 19
Motivational Interviewing and Caregiving
Motivational Interviewing and Caregiving • Person-centered approach • Focuses on problem-solving • Not giving advice • Applicable to whatever issue the caregiver wants to discuss • Allows for teaching skills such as realistic goal setting
Motivational Interviewing and Ambivalence • Motivational interviewing can resolve ambivalence • Techniques to resolve ambivalence • Comparing and contrasting the good and bad aspects of not engaging in self care • Matching with goals such as wanting to continue to care give or keep a family member in the home
Motivational Interviewing Tools Decisional Worksheet 23
Decisional Worksheet Homework • Complete the worksheet with a caregiver. While doing this exercise explore the pros and cons of the behavior. • Introduce the decisional worksheet, explaining that you want to explore the pros and cons of an area change • Begin with the pros and cons of continuing and conclude with the pros and cons of stopping the behavior • Offer information and advice as needed or as requested. Remain neutral and provide mini-summaries throughout the process • Invite the person to examine their needs and desires to change • Complete the summary post decisional worksheet with the client 24
Question Prompts for the Decisional Worksheet Exercise • • • What do you think needs changed? What concerns do you have about change? What are your options? What do you think you will do? What’s the next step? 25
Decisional Worksheet Maintaining Behavior Pros (Benefits) Continuing Behavior Cons (Costs) Pros (Benefits) 26
Decisional Worksheet Exercise Summary • • • Summarize the perception of the behavior Identify any change statements made Discuss ambivalence including the pros and cons of the behavior Identify risk factors and consequences of continuing the behavior Reflect indications of wanting, or intending to change Prompt consideration of the next step in the process of change 27
Case Study Discussion
Caregiver Case Study Think about this situation as if you were really in the situation, with that person talking to you. What is the next thing that you would say if you wanted to be helpful. Write only one or two sentences • Helen Thomas is a 94 -year-old Caucasian widow who resides in a nursing home. Mrs. Thomas suffered a Cerebral Vascular Accident nine months ago and entered the nursing facility three months later after fracturing her right hip and falling in her home. She has difficulty feeding herself, is nearly deaf in both ears, and suffers from poor vision. The stroke has left her extremely weak, and she is confined to a wheelchair. . Mrs. Thomas’ 68 -year-old daughter, Karen, devotes a majority of her time to attending to her mother’s care at the nursing home. Karen arrives every morning at 10: 00 to visit her mother and remains at the nursing home until 8: 00 each night. • Karen is in poor health herself, and has been diagnosed with Type II Diabetes, hypertension, and kidney problems. Karen has been hospitalized twice due to complications with her diabetes and a fall, which resulted in a broken ankle. She has lost almost fifteen pounds in the last five months. • Karen says to you that she needs some time to herself but feels guilty anytime she leaves her mother. She says her husband tells her she is over involved with her mother and that the Council on Social Work Education (n. d. ). Hospice social work and caregiver stress: case study. Retrieved from: nursing home staff are there to take care of her mother. Karen says she just want to show her https: //pogoe. org/ mother that she is not alone and make sure that she gets the best care possible.
Post Assessment
Motivational Interviewing: Knowledge Assessment • Which of the following is NOT a guiding principle of Motivational Interviewing? • Empower your caregiver • Listen to your caregiver • Create change goals for your caregiver • Understand your caregiver’s motivation • From the Motivational Interviewing approach, who is/are considered the expert(s)? • The Caregiver • The Counselor • Neither the caregiver or counselor • Both the caregiver and counselor
Questions? Next Session: Activation, Communication Tools, and Agenda Setting 32
- Slides: 32